Wiki Tele-Medicine Visits with Zoom

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LeaHarris

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The clinic I work for (FQHC) has recently decided to trial some tele-visits through Zoom. So far we have done a home visit (patient at home, and provider in office) and an office visit (patient in office and provider in another location). Just wondering if anyone has experience with this? I am not sure the requirements that need to be meet, for example there were no vitals collected on the visit in which the patient was at home and the provider was in office. Is it really as simple as coding the visit and adding the GT modifier for Tele services? If I can recall correctly, the visit is billed based off of where the patient is located so the patient that is at home for the zoom visit will be billed a home visit?

Thanks for any thoughts!
 
you really need to read the telehealth requirements before billing.
The patient cannot be in their home when the service is rendered they must be located in a qualifying rural area and a qualifying originating site such as a clinic or physician office or rural facility. you do not use the GT modifier as of Jan 2018 you use the 02 POS and for commercial payer add the 95 modifier.

If you are the originating site you must be in a qualifying rural area and you bill only the G code for originating site. The distant site provider will bill their service as the office visit with POS 02.
 
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Thank you, I will continue to research. I am thinking we are not in compliance with guidelines (although I am still researching) as my provider is at the office and the patient's are at their home. I really appreciate the help!
 
Here is the Medicare section to look up
42 CFR § 410.78(b)). To support rural access to care, Medicare pays for telehealth services provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner located at a distant site. An eligible originating site must be the practitioner’s office or a specified medical facility, not a beneficiary’s home or office.
 
So I suppose I have two scenarios:
First: the zoom visits in which our in-house MD is zooming to a visit outside our location (not billable)
then there is a zoom visit in which our in-house MD is off-site (hospital or another office) and does a zoom visit to our location, FQHC (billable) - The G codes don't seem appropriate for this, it seems like I should do a telehealth POS with a 95 modifier, am I on the correct track here?



Second: Our psychologist is at his home office across the state and he completes telemedicine visits to patients at our site (FQHC) by interactive video conferencing. I am billing for the psychologist's services as he is a contract worker for our facility. Is this the same, he bills the appropriate E/M and we attach the telehealth POS and modifier 95? I still have insurance companies requesting the GT modifier so perhaps that varies by payer.
 
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